Care Navigator Coordinator

POSITION SUMMARY

The Care Navigator Coordinator serves as a trusted, high-touch advocate and primary non-clinical point of contact for patients within the MSO/IPA's Medicare Advantage and full-risk value-based care population. The Navigator helps senior patients and caregivers overcome language, access, logistical, pharmacy, benefit, and social barriers so they can successfully complete recommended care and remain connected to their Primary Care Provider (PCP) and broader care team.

This role may be embedded at an affiliate PCP practice or based in a centralized Care Navigation Center and works closely with patients, caregivers, PCPs, specialists, pharmacies, diagnostic facilities, health plans, brokers, and the MSO/IPA clinical team. The Care Navigator owns assigned patient needs through resolution or appropriate handoff.

PILOT PROGRAM — INITIAL PHASE (LOS ANGELES / ORANGE COUNTY)

The first two Care Navigator Coordinators will launch the pilot at two SMG-owned practices — Buena Park (Orange County) and central Los Angeles. During the initial phase, the role concentrates on four core services: (1) Korean language translation, (2) appointment scheduling, (3) arranging transportation, and (4) pharmacy assistance. Korean English fluency is required for these pilot assignments. The posting targets the Los Angeles / Orange County market today and will be adjusted for future markets — including centralized Care Navigation Centers — as the program expands.

The duty areas below are sequenced accordingly: the four pilot services first, followed by the broader coordination duties that phase in as the program scales.

ESSENTIAL DUTIES & RESPONSIBILITIES

Korean Language & Cultural Support

• Provide Korean-English language assistance for navigation, scheduling, pharmacy, benefit, and care-coordination needs within organizational policy.
• Recognize cultural, language, and health-literacy barriers that may affect patient engagement and communicate those needs to the care team.
• Coordinate qualified medical interpretation when clinical interpretation exceeds the Navigator's authorized role.

Specialist, Imaging & Clinical Appointment Coordination

• Assist with scheduling specialist visits, advanced imaging, diagnostic testing, laboratory services, therapy, rehabilitation, home health, and other ordered services.
• Track referrals, orders, and appointments through completion; follow up on missed or delayed care and help resolve barriers.
• Assist with authorization-status follow-up and escalate unresolved authorization issues to the appropriate MSO/IPA team.
• Coordinate appointment reminders, transportation needs, records availability, and other logistics needed to complete care.

Transportation, Social Needs & Community Resource Navigation

• Coordinate transportation support for medical appointments when available.
• Identify barriers such as transportation, food insecurity, housing or home-safety concerns, financial hardship, social isolation, caregiver needs, mobility limitations, and language barriers.
• Connect patients and families with available health-plan, community, government, and social-service resources.
• Escalate complex social work, behavioral health, safety, abuse/neglect, or crisis concerns in accordance with policy.

Pharmacy & Medication Access Support

• Contact pharmacies, when authorized, to assist with prescription status, refill logistics, medication availability, pickup, and delivery coordination.
• Facilitate communication among the patient, PCP, pharmacy, health plan, and care team when medication-access problems occur.
• Identify and escalate formulary, prior authorization, affordability, refill, or adherence barriers to the appropriate clinical or pharmacy resource.
• Do not independently provide medication advice, recommend medication changes, or alter a prescribed treatment plan.

Patient Advocacy & Navigation

• Serve as a consistent point of contact for assigned patients and caregivers, providing culturally sensitive, high-touch support.
• Conduct inbound and proactive outbound outreach; identify barriers to care and coordinate practical solutions.
• Help patients understand the next steps, appointment logistics, referrals, health-plan communications, and available resources.
• Escalate unresolved clinical, behavioral health, safety, or complex psychosocial needs to the appropriate licensed team member.

Health Plan Benefit & Broker Coordination

• Help patients access existing health-plan benefits and connect them with Member Services when benefit coordination is required.
• With patient authorization, facilitate a warm handoff to the patient’s broker of record when broker involvement is appropriate — for example, to clarify plan benefits such as transportation services, particularly during AEP.
• Support access to covered transportation, pharmacy, DME, dental, vision, hearing, OTC, and other applicable supplemental benefits.
• Do not recommend plan enrollment, market insurance products, or perform services requiring an insurance license unless separately licensed and authorized.

High-Risk Patients, Transitions of Care & Value-Based Care

• Provide enhanced navigation for high-risk, complex, homebound, recently hospitalized, and otherwise vulnerable patients.
• Support post-hospital and post-emergency department outreach and facilitate timely PCP follow-up, specialist care, diagnostics, pharmacy access, and transportation.
• Support outreach for Annual Wellness Visits, preventive services, chronic-care follow-up, and other clinically directed population-health initiatives.
• Help close outstanding referrals, diagnostic orders, and care-coordination tasks; engage difficult-to-reach patients and reconnect them with longitudinal primary care.
• Participate in interdisciplinary case reviews and care-team meetings as requested.

Documentation & Communication

• Accurately document patient interactions, needs, outreach attempts, interventions, referrals, appointments, and follow-up activities in designated navigation tracking tools; the Care Navigator does not document in the practice’s EHR.
• Maintain organized worklists and follow-up queues; communicate outstanding needs to PCP practices and appropriate MSO/IPA departments.
• Protect patient confidentiality and comply with HIPAA and organizational privacy requirements.

SCOPE OF ROLE

This is a non-clinical care coordination and patient advocacy role unless the individual separately holds an applicable clinical license. The Care Navigator may identify needs, coordinate services, facilitate communication, and connect patients with resources, but does not independently diagnose conditions, provide medical or medication advice, change treatment plans, perform independent clinical assessments, or deliver services reserved for a licensed social worker, nurse, pharmacist, behavioral health professional, or other clinician. The Care Navigator does not use, access, or document in the practice’s electronic health record (EHR).

MINIMUM QUALIFICATIONS

• High school diploma or equivalent required; Associate or Bachelor's degree preferred.
• Bilingual fluency required (market-dependent); Korean English required for current Los Angeles / Orange County assignments.
• Demonstrated ability to communicate effectively with senior/geriatric patients and caregivers.
• Strong customer service, organization, follow-through, problem-solving, and multitasking skills.
• Ability to handle protected health information with discretion and comply with privacy requirements.

PREFERRED QUALIFICATIONS

• Two or more years of experience in healthcare, care coordination, patient navigation, medical-office operations, community health, social services, or a related patient-facing environment.
• Working knowledge of medical terminology, referrals, specialist workflows, pharmacies, diagnostic services, and health-plan processes.
• Experience using care management, CRM, or similar tracking systems.
• Additional language capabilities a plus as the program expands to new markets (e.g., Mandarin).
• Bachelor's degree in social work, Public Health, Health Sciences, Healthcare Administration, Psychology, Sociology, or related field.
• Experience supporting Medicare Advantage, senior, full-risk, or value-based care populations.
• Experience in an IPA, MSO, medical group, health plan, primary-care practice, PACE, or senior-focused healthcare organization.
• Experience coordinating referrals, authorizations, pharmacy services, diagnostic imaging, transportation, and/or community resources.
• Community Health Worker, Patient Navigator, Care Coordination, Medical Assistant, or medical interpretation training/certification.

KEY PERFORMANCE INDICATORS

• Timeliness of response and completion of assigned navigation tasks.
• Specialist, diagnostic, and referral/order completion rates.
• Successful resolution or escalation of pharmacy and access barriers.
• Post-discharge outreach and PCP follow-up completion.
• Reduction in unresolved care barriers and missed appointments.
• Timeliness and accuracy of documentation.
• Patient/caregiver and PCP/practice satisfaction with navigation support.
• Successful engagement of high-risk and difficult-to-reach patients.

AMM BENEFITS

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On : Full employer-paid HMO and the option for a flexible PPO plan .
• Wellness Made Affordable : Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending : FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance : Generous PTO , 40 hours of sick pay , and paid holidays to enjoy life outside of work.
• Career Development : Tuition reimbursement to support your education and growth.
• Team Fun : Paid company outings and lunches because we work hard, but we also know how to have fun!